One page summary: Brachial plexus birth injury

In two sentences

The brachial plexus is the bundle of nerves that runs from the neck through the shoulder and down the arm. A brachial plexus birth injury means those nerves were stretched or torn during birth, so the arm does not move normally. ¹

Most babies recover. The single most important thing to track is whether movement is returning, and the first few months decide whether surgery is considered. If your baby is not recovering meaningful shoulder and elbow movement by around 3 to 6 months, ask for referral to a specialist brachial plexus center. ¹

The numbers, with their sources

• How often it happens. Around 1.5 per 1,000 live births in the United States, based on a national inpatient sample analysis ¹
• The main risk association. Shoulder dystocia, where the baby's shoulder is stuck behind the pubic bone after the head is born ²
• It also happens without shoulder dystocia. A substantial share of these injuries occur in births with no recorded shoulder dystocia, and some occur in cesarean births ²
• Most recover. The majority of babies recover full or near-full arm function, most of them in the first months ¹
• The decision window. Failure to regain meaningful elbow and shoulder movement by around 3 to 6 months is the usual trigger for surgical evaluation ¹
• What must not be skipped. Daily gentle range-of-motion movement from the start, because a joint that stiffens while a nerve recovers limits the final result ¹

What to do this week

1. Ask for the delivery note and the shoulder dystocia note if there was one, including which maneuvers were used, in what order, and the times.
2. Ask for a therapy referral today and get shown the daily range-of-motion exercises.
3. Ask which nerve levels are affected and what movements are being tracked.
4. Ask when the specialist brachial plexus referral happens. If nobody has mentioned it, ask for it.
5. Ask whether the collarbone was X-rayed and whether breathing is normal.
6. Film the arm weekly, in the same position, so recovery is visible over time.
7. Request the complete records with the records request builder.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the pediatrician or neonatologist

• Which nerve levels appear to be affected?
• Is the hand working? Is the diaphragm working?
• Was the collarbone X-rayed?
• Is there a droopy eyelid or a smaller pupil on that side?

For the brachial plexus specialist

• What is the injury type at each level, as best you can tell?
• What movements are you tracking, and what would you expect by 3 months and by 6 months?
• At what point would you consider surgery, and what would it be?
• What happens if we wait too long?

For the therapist

• Show me the exercises and watch me do them.
• How many times a day, and what does too much look like?
• How do we encourage my baby to use that arm?
• What position should the arm be in when sleeping and in the car seat?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Brachial plexus birth injury

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.